A recent study has found that females who stop having their periods before age 46 had a higher incidence of heart disease and stroke.

Doctors have long suspected that women who undergo early menopause might be at an increased risk for those medical problems because of their loss of the hormone estrogen.

The study, published in the October issue of Menopause: The Journal of the North American Menopause Society, found that women who underwent early menopause were about twice as likely to eventually have coronary artery disease and stroke.

Because heart disease is the No. 1 killer of women, the authors of the study said they wanted to uncover the effects of menopause on cardiovascular health.

"When people think of the two (heart disease and menopause), they think of it as women don't need to worry about heart disease until after the age of menopause," said Dhananjay Vaidya, an author of the study who oversaw the research. "We're coming to the conclusion that that's not the case, that heart disease in women needs to be considered and prevented much earlier in life."

Researchers used women from the Multi-Ethnic Study of Atherosclerosis, which included 2,509 women age 45 to 84 enrolled in 2000 to 2002 and followed until 2008. The study looked at the association between a personal history of menopause (either natural or surgical before age 46) and future coronary heart disease and stroke.

The study authors noted that removal of ovaries during hysterectomy could increase risk. More research was needed to help women "weigh" the benefits and risks of hysterectomy and removal of the ovaries, they said. Vaidya said some studies had linked better nutrition with decreased risk of the diseases.

Vaidya, assistant professor in the division of general internal medicine at Johns Hopkins University School of Medicine, said the recent study found that women who smoke undergo menopause two years before those who don't.

Dr. Michelle Wellons, lead study author, noted that a number of other studies linked early menopause with heart disease, but that research focused on European women, who were usually white.

"This was different because it looked at women from multiethnic populations" said Wellons, assistant professor of medicine in the division of diabetes, endocrinology and metabolism at Vanderbilt University Medical Center in Nashville, Tenn. "It's a more ethnically diverse population that better represents the United States now."

Wellons said researchers still didn't fully understand the link between menopause and heart disease, though they speculated loss of estrogen contributed.

The article was submitted while Wellons was at the University of Alabama at Birmingham.

Dr. Michael Chen of Rush University Medical Center said he was impressed by the study findings, including the large number of patients followed. Chen noted the study found that even after adjusting for other vascular risk factors, the researchers found a correlation between early menopause and heart disease.

"I think it really does sort of revise the (estrogen) hypothesis again," said Chen, assistant professor of neurology, neurosurgery and radiology.

Chen also is studying the connections between menopause and cerebral aneurysms. About 70 percent of all aneurysms occur in women, with the peak age being 52, he noted. If a lack of hormones were contributing, hormonal therapy might even be beneficial for younger women who have had an aneurysm and are at risk for another, he noted.

"It would be nice to offer a therapy that could potentially be related to hormones that would not entail surgery," Chen said.